Healthcare Provider Details

I. General information

NPI: 1497234991
Provider Name (Legal Business Name): JESSICA ANNE PRESTIA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2018
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 W COLUMBIA AVE
BATESBURG SC
29006-2124
US

IV. Provider business mailing address

117 PORT O CALL PL
LEESVILLE SC
29070-7027
US

V. Phone/Fax

Practice location:
  • Phone: 803-532-2586
  • Fax: 803-532-6644
Mailing address:
  • Phone: 864-999-0291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH031262
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number37850
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: